Background. There is a category of patients with renal masses, due to severe concomitant diseases, can not perform the operation or may be associated with a threat to life. In addition, many patients with small tumor sites are extremely concerned about their disease and are negative about the tactics of active observation and insist on treatment. These patients can be offered alternative methods of treatment of renal cell carcinoma (RCC), the leading of which is cryoablation.Objective: to evaluate the effectiveness and safety of percutaneous cryoablation of the kidney tumor under ultrasound control.Materials and methods. In the Urology Clinic of the I.M. Sechenov First Moscow State Medical University during the period from 2015 to 2017 performed 23 percutaneous cryoablation of RCC, 7 (men – 4, women – 3) of which were performed under local anesthesia. In 4 patients due to severe concomitant diseases, general anesthesia was associated with an extremely high risk. Three patients refused from dynamic observation and from traditional surgical treatment; preferred an alternative treatment in the form of a percutaneous cryoablation under local anesthesia. In 4 cases, the formations were located in the lower segment along the posterior surface of the kidney, in 3 – along the lateral surface in the middle segment. The size of the formations was not used 4 cm (T1a). The age of the patients was 62.3 years (51 to 83 years). Right-sided localization of the tumor was noted in 3 patients, left-sided – in 4. One patient had a single kidney.At the preoperative stage and 6 months after the operation, all patients underwent ultrasound with dopplerography, multislice computerized tomography with contrast, and computer 3D modeling, which helped to clearly assess the size of the tumor, clarify the prevalence of the tumor process and the spatial ratio of the internal surface of the tumor node to the elements of the bowl-and-pelvis system. In all the observations, the formations were located along the posterior or lateral surface of the kidney; in the lower or middle segment; without invasion of the sine. We used a 3rd generation cryomash machine SeedNet gold (Galil Medical), cryoprobes IceSeed and IceRod. Intraoperative, immediately before cryoablation, a tumor biopsy was performed, the presence of RCC in all patients was confirmed morphologically.Results. According to the ultrasound examination with echodopplerography at 6 months after the operation, the size of the tumor node’s formations decreased on average by 6–8 mm, while there was no blood flow in them. When multislice computerized tomography with 3D modeling was performed, the formation was reduced and the accumulation of the contrast preparation was completely absent or their accumulation gradient did not exceed 10 HU (initially it was about 200 HU). There were no intraoperative complications. In 1 observation, a postoperative hematoma measuring 7 × 3 cm was resolved conservatively and did not require surgical treatment.Conclusions. Percutaneous cryodestruction under local anesthesia using ultrasound guidance seems to be an effective and safe technique for treating patients with stage T1a RCC with localization in the posterior or lateral surface in the lower or middle segments without invasion of the renal sinus and surrounding tissues. It is planned to continue monitoring patients to assess the long-term effectiveness of cryoablation.

Background. Considering decreasing age of patients with prostate cancer, increasing cancer alertness of first-line doctors as well as increased frequency of radical prostatectomies (RP), the problem of preservation of erectile function (EF) is vitally important (erectile dysfunction develops in 25–75 % of all patients who underwent surgery).The study objective is to analyze preservation of EF after RP depending on the type of endoscopic access and nerve preservation.Materials and methods. Between February of 2015 and February of 2016, in the Urology Clinic of the Sechenov University, 507 RPs were performed; the retrospective single-center study included 231 patients with localized prostate cancer. Surgery was performed with the following accesses: laparoscopic, extraperitoneal laparoscopic, and robotic. Indications for nerve preservation were formulated based on the Briganti nomogram, Partin table as well as patient’s desire to preserve EF. Further evaluation of EF was performed using the International Index of Erectile Function (IIEF5), evaluation of quality of life – using the QoL (Quality of Life) scale.Results. RP with nerve preservation was performed in 150 patients. Surgical time and blood loss did not significantly differ for surgeries with and without nerve preservation (р = 0.064 and р = 0.073 respectively). Pathomorphological examination showed that in all cases (n = 231) integrity of the prostatic capsule and negative surgical margin were achieved. Frequent significant erectile dysfunction and full loss of EF were observed in patients after RP without nerve preservation compared to the group with preserved neurovascular bundles (5.0 (0.0–10.0) points compared to 6.5 (0.8–19.0) points per the IIEF5 scale, р = 0.271): 96.2 % versus 72.2 % (p <0.001). Nerve preservation significantly improved quality of life: 1.63 ± 1.16 points versus 1.88 ± 1.02 points per the QoL scale (р = 0.035).Conclusions. The best results were achieved in the robotic access group. Surgery with nerve preservation decreased frequency of EF loss. This benefit in conjunction with the radical nature of the operative intervention allows to consider RP techniques with nerve preservation as reasonable approach to erectile dysfunction prevention in patients with localized prostate cancer.

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The current prostate cancer screening program results in unnecessary biopsies in a quarter of patients, overdiagnosis of clinically insignificant prostate cancer (ISUP 1) and overtreatment. Intoducing multiparametric magnetic resonance imaging into routine practice before biopsy allows to decrease the number of biopsies, thereby reducing the burden on clinicians and increasing the likelihood of detecting clinically significant forms of prostate cancer (ISUP >2).  The objective of this literature review is to compare targeted biopsy techniques and to determine their current role in the prostate cancer diagnosis.

The study objective is to improve results of treatment of patients with prostate cancer (PC) and low oncological risk.Materials and methods. Since November of 2019 at the Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University 40 patients with PC and low oncological risk were included in the protocol of active observation. In all patients, the level of prostate-specific antigen was evaluated every 3 months, digital rectal examination was performed every 6 months, magnetic resonance tomography of the pelvis with intravenous contrast was performed every 12 months. Confirming biopsy of the prostate was performed once, 1 year after the beginning of observation. Every 6 months patients' quality of life was evaluated using the SF-36 (Short Form 36 Health Quality Survey), IIEF-5 (International Index of Erectile Function), IPSS (International Prostate Symptom Score), EPIC-26 (Expanded Prostate Cancer Index Composite) questionnaires.Results. Two (5 %) patients underwent surgical treatment due to PC progression. One (2.5 %) patient preferred treatment due to oncological anxiety. Mean value per the SF-36 questionnaire at the beginning of the study was 63.2 ± 11.5 for psychological component of health and 57.1 ± 9.8 for physical component of health. At the moment, the assessment of the psychological and physical components of health according to SF-36 is 69.5 ± 12.4 and 66.3 ± 8.9 points, respectively. Mean IIEF-5 value at the beginning of the study was 18.8 ± 4.2, currently it is 18.6 ± 3.9. At the beginning of the study mean IPSS value was 9.1 ± 2.1, currently it is 9.4 ± 1.9. For the EPIC-26 questionnaire mean value for all criteria initially was 56.1 ± 5.1, currently it is 68.2 ± 4.6.Conclusion. First results of active observation of patients with PC and low oncological risk demonstrated that this approach allows to avoid unnecessary treatment of patients who do not require immediate intervention and to start treatment on time in cases where it is required while preserving high quality of life for the patients.